Designing a Cost Management Framework for a Medical Scheme Service Provider in South Africa

Elbie Ward, Susanna L Middelberg () and Pieter Buys ()
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Elbie Ward: North-West University
Susanna L Middelberg: North-West University
Pieter Buys: North-West University

Chapter Chapter 5 in Designing Cost Management Systems to Support Business Decision-Making, 2021, pp 87-105 from Springer

Abstract: Abstract The South African medical scheme environment is heavily regulated. Furthermore, healthcare costs are continuously on the rise, requiring medical schemes to be creative in managing their costs while offering quality healthcare. One of the innovative ways to manage costs, is channelling its members towards a cost-efficient, high quality medical specialist’s network. This case study focuses on the development of a framework that is able to detect and recommend the most cost-effective route in identifying quality medical specialists and channelling members thereto. The results illustrate that channelling members to cost-efficient, quality medical specialists can lead to substantial cost savings for the medical scheme. Through the involvement of key stakeholders, a solution was found to the problem of increasing medical costs to the benefit of all.

Keywords: Cost management; Healthcare service providers; Medical costs; Service provider networks (search for similar items in EconPapers)
JEL-codes: I13 I18 M41 (search for similar items in EconPapers)
Date: 2021
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Persistent link: https://EconPapers.repec.org/RePEc:spr:sprchp:978-981-16-1751-5_5

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DOI: 10.1007/978-981-16-1751-5_5

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